Many Adults Have Never Seen a Health-Care Provider for Chronic Joint Symptoms

Arthritis and chronic joint symptoms (CJS) are a leading cause of disability among adults in the United States (1,2). For some forms of arthritis, early diagnosis and aggressive treatment are essential to limit permanent joint damage and disability (3). Because CJS can signal inflammatory arthritis, patients with CJS should consult a health-care provider to rule out rheumatoid arthritis and other forms of inflammatory arthritis. To characterize persons with CJS who do not see a health-care provider, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of the analysis, which indicate that, during 2001, approximately 10.3 million adults (21.7% of adults with CJS), including 2.0 million with activity limitations, had never seen a health-care provider for their joint symptoms. These persons are missing opportunities to limit joint damage and disability and to improve health and functional status.

BRFSS is a random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged >18 years. BRFSS is administered in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands (4). Respondents were classified as having CJS if they responded "yes" to two questions: "In the past 12 months, have you had pain, aching, stiffness, or swelling in or around a joint?" and "Were these symptoms present on most days for at least a month?" Respondents who did not know, were not sure, or refused to answer were classified as not having CJS. Having seen a health-care provider was determined by asking, "Have you ever seen a doctor, nurse, or other health professional for these joint symptoms?" The following question addressed activity limitations: "Are you now limited in any way in any activities because of joint symptoms?" The median response rate for the 2001 BRFSS was 51.4%. Data were weighted by age and sex to reflect each state's most recent adult population estimates. SUDAAN was used to calculate point estimates and 95% confidence intervals. Logistic regression modeling was used to produce age-adjusted odds ratios for each variable and for a full model that adjusted for all variables.

In 2001, an estimated 47.5 million adults had CJS. Of these, approximately 10.3 million (21.7%) never had seen a health-care provider about their joint symptoms, including 2.0 million who reported activity limitations because of such symptoms. Prevalence of never having seen a health-care provider about joint symptoms was highest among younger persons; males; Hispanics; and those with a high school education or less; excellent, very good, or good health; no health insurance; no personal doctor; or no activity limitation because of joint symptoms (Table 1). These variables were significantly associated with never having seen a health-care provider in age-adjusted analysis and in the full model, which also showed that respondents who engaged in recommended physical activity levels* were less likely to see a health-care provider. Additional models compared those with activity limitations who did and did not seek medical care. Lack of health insurance and having no personal doctor were strongly associated with not seeing a health-care provider for CJS.

The median state prevalence for persons never having seen a health-care provider for symptoms was 21.1% and ranged from 13.5% in Puerto Rico to 37.2% in Guam (Table 2). Prevalence was highest in the south and west and lowest in the northeast and Puerto Rico (Figure).

This report provides the first state-specific estimates that describe the prevalence among persons with CJS of not seeing a health-care provider for their joint symptoms. Approximately one fifth of the estimated 47.5 million U.S. adults with CJS never have seen a health-care provider for their joint symptoms. Possible explanations for these findings are that those not seeking medical care might have milder disease and opt for self-treatment. Some might face barriers to treatment, such as not having health insurance or a personal doctor; however, most persons had both. In addition, persons with CJS who have co-morbidities might not get care for joint symptoms because arthritis usually is not life threatening and might be given lower priority by patients and doctors. Finally, the belief that arthritis is a normal part of aging and the lack of awareness that effective interventions are available for arthritis might play a role (5).

The findings in this report are subject to at least five limitations. First, data are self-reported and not confirmed through medical record review. Second, the sample is drawn from the civilian, noninstitutionalized adult population and excludes those in the military and in institutions. Third, BRFSS is a telephone survey that excludes those who have no phone service. Fourth, the median response rate was 51.4%; however, demographic distribution in the BRFSS sample was similar to the distribution based on the U.S. census estimates (e.g., sex, age, and racial/ethnic data). Finally, some who meet the CJS definition might have acute self-limited injuries instead (CDC, unpublished data, 2001).

The findings in this report are based on large, representative state-level samples whose sizes ranged from 871 to 8,628, with a total sample size of 212,510. Among persons who did not see health-care providers for their joint symptoms, some are missing opportunities to limit joint damage and disability and to improve their health and functional status. In addition to making it possible to diagnose and treat inflammatory arthritis, early care seeking for symptoms helps patients obtain appropriate management (e.g., advice about physical therapy, medication, weight reduction, and physical activity). Health-care providers also might refer patients to self-management courses such as the Arthritis Self-Help Course, an educational program that provides information about arthritis, medications, joint protection, exercise, and pain management. This course has helped persons with arthritis reduce pain and clinical visits (6).

This report provides a baseline national estimate of 78.3% for the national health objective for 2010, which calls for increasing the proportion of adults who have seen a health-care provider for their chronic joint symptoms (objective 2-7) (7) and indicates that a large group of persons might benefit from intervention.
BRFSS is a random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged >18 years. BRFSS is administered in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands (4). Respondents were classified as having CJS if they responded "yes" to two questions: "In the past 12 months, have you had pain, aching, stiffness, or swelling in or around a joint?" and "Were these symptoms present on most days for at least a month?" Respondents who did not know, were not sure, or refused to answer were classified as not having CJS. Having seen a health-care provider was determined by asking, "Have you ever seen a doctor, nurse, or other health professional for these joint symptoms?" The following question addressed activity limitations: "Are you now limited in any way in any activities because of joint symptoms?" The median response rate for the 2001 BRFSS was 51.4%. Data were weighted by age and sex to reflect each state's most recent adult population estimates. SUDAAN was used to calculate point estimates and 95% confidence intervals. Logistic regression modeling was used to produce age-adjusted odds ratios for each variable and for a full model that adjusted for all variables.